Healthcare Provider Details

I. General information

NPI: 1477527125
Provider Name (Legal Business Name): CRISTIN ANN MOUNT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
JBLM TACOMA WA
98431
US

IV. Provider business mailing address

102 LAKE LOUISE DR SW
LAKEWOOD WA
98498-3144
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-5074
  • Fax:
Mailing address:
  • Phone: 253-381-2986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number23113
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number23113
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD60186225
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: